Treatment of pulmonary thromboembolism in patients with systemic blood pressure stability and right ventricular dysfunction
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Review
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Abstract
Pulmonary thromboembolism (PTE) ranges from incidental, clinically unimportant thromboembolism to massive embolism with sudden death. Its treatment is well established in two groups of patients: heparin for those with normal systemic blood pressure without right ventricular dysfunction (RVD) and thrombolysis for those with RVD and circulatory shock. In an intermediate group of patients with systemic blood pressure stability combined with RVD, which is usually associated with worse outcome, the treatment is controversial. There are authors who strongly suggest thrombolysis while others contraindicate this procedure and recommend anticoagulation with heparin. This is a narrative review that includes clinical trials comparing thrombolysis and heparin for the treatment of PTE patients with systemic blood pressure stability and RVD published since 1973. The results show that there are only four trials on this subject with less than 500 patients. Many PTE patients with systemic blood pressure stability and RVD might benefit from thrombolysis but, on the other hand, the risk for hemorrhagic events may be increased. Large randomized clinical trials are required to clarify this. © 2008 Bentham Science Publishers Ltd.
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Keywords
Pulmonary thromboembolism , Right ventricular dysfunction , Systemic blood pressure , Thrombolysis , Treatment , alteplase , anticoagulant agent , antivitamin K , fibrinolytic agent , heparin , low molecular weight heparin , nadroparin , streptokinase , urokinase , warfarin , bleeding , blood pressure monitoring , brain hemorrhage , clinical trial , combination chemotherapy , continuous infusion , drug clearance , drug contraindication , drug efficacy , drug indication , drug metabolism , drug response , drug safety , drug withdrawal , echocardiography , embolectomy , evidence based medicine , fibrinolytic therapy , gastrointestinal hemorrhage , heart dilatation , heart right ventricle failure , hemodynamic monitoring , high risk patient , human , hypotension , lung embolism , monotherapy , outcome assessment , practice guideline , priority journal , prognosis , retroperitoneal hemorrhage , review , risk assessment , risk benefit analysis , shock , sudden death , survival rate
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English
Citation
Current Respiratory Medicine Reviews, v. 4, n. 1, p. 52-56, 2008.
